1 / 69

It Is Not A Hospital Discharge… It Is A Community Admission

It Is Not A Hospital Discharge… It Is A Community Admission. It Is More Than Health Care ... Fitting the pieces together. Socia l. Literature. $. Dev/Educ. Technol. OVERVIEW. Medical Home for CWD - a little different Working with the educational system

rowdy
Download Presentation

It Is Not A Hospital Discharge… It Is A Community Admission

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. It Is Not A Hospital Discharge… It Is A Community Admission

  2. It Is More Than Health Care...Fitting the pieces together Social Literature $ Dev/Educ Technol

  3. OVERVIEW • Medical Home for CWD - a little different • Working with the educational system • IFSP and early intervention programs • IEP and the education system • ITP and transition to adulthood • Accessing community resources • parent educ, advocacy, support • community agencies • respite and recreation • financial • Educating the PCP

  4. Special KidsSpecial Skills ???(not really)

  5. But, a few more.... • assessment tools • team members • community supports • minutes • dollars

  6. Medical Home • traditional pediatric care • emphasizes a mutual relationship • broad health care plan • medical (traditional and non-traditional) • developmental • behavioral • educational • social • long range (infancy to adulthood)

  7. Components of any Medical Home (MH) • accessible • continuous (age & spectrum of care) • compassionate • comprehensive • coordinated • culturally competent • family-centered

  8. Child/Family, includes family support resources Pediatrician and other medical providers School, includes early intervention Community-Based Team Insurance providers/financial resources Religion /spiritual supports Social Services, includes mental health

  9. CWD: Additional Components Broader array of assessment tools Awareness of community resources Team Skills vs Care Coordination Skills: • medical and surgical subspecialists • social workers and home health nurses • therapists, orthotists, prosthetists, DME vendors • intervention specialists, teachers, ed diagnos • counselors, psychol, behavior mgmt specialists Advocacy Skills: • authorizations for medical care • authorizations for school related services • financial assistance programs • public policy issues

  10. The “Standard” Assessment • History • Chief complaint • History of present illness • Pregnancy and neonatal history • Family history • Developmental and school history • Review of systems • Physical Exam • Screenings • hearing and vision • growth and development • dental • Hct, etc

  11. Beyond the “Standard” Assessment • Developmental • Socio-emotional • Functional • Educational • Transitional

  12. Developmental • AAP emphasis on the developing brain • Developmental monitoring • Screening • Surveillance • Assessment • Goal: Early referral to an early intervention program (EIP)

  13. Questionnaires PDQ AAP EIP Customized Observation Denver - II ELMS CAT/CLAMS BINS Dev Profile - II Screening Tools

  14. Surveillance • The art of being suspicious • Parental concerns are valid!!! • Continuous monitoring at every visit • Pre-printed milestone checklists • Developmental milestone tables (texts/articles) • Use of standardized tools to validate suspicions • Developmental age for eachstream developmental age chronological age > 85% is normal 70 - 85% is suspect < 70 %is abnormal

  15. EXAMPLES 10 mos old w/ GM skills solid to 8 mos 8 mos = 80% 10 mos 10 mos old w/ GM skills solid to 6 mos 6 mos = 60% 10 mos

  16. Developmental Assessment • Targets children at risk • Time consuming • Requires training and expertise • Often performed by a team • Assesses quality as well as skill level • Addresses etiology (neuro, genet, etc)

  17. Functional Assessment • Follows developmental assessments • Assesses the child’s ability to perform skills independently w/wo devices • Mobility • Communication • Self Help: feeding, dressing, hygiene • Standardized tools • Vineland • WeeFIM • PEDI • AAMR

  18. Early Intervention Programs • Available to infants from the time of diagnosis until age 3 years • Known disability • Developmental delay • At risk for disability or delay • Promote development & family function • Mandated by the IDEA entitlement • Large menu of services • parent education, empowerment, advocacy • habilitation services (OT, PT, ST, behav mgmt) • assistive technology • respite, transportation, etc

  19. Evolution of IEP’s • Privately funded . . . . Publicly funded • Open referral . . . . . . Geographic assign • Multidisciplinary . . . . Transdisciplinary • Center-based . . . . . . . Home based or DCC • Child centered . . . . . . Family centered • IDP. . . . . . . . . . . . . . . . .IFSP

  20. EIP:Pediatrician’s Role • Referral - early, don’t wait for DX - “48 Hour Rule” • Medical assessment • etiology vs co-existing disorders • subspecialty consultations • Care Coordination • Development of the IFSP • Authorizations for treatment • Education of providers re: diagnosis • Communication and monitoring

  21. Transition to School • Occurs at age three years • Individual Education Plan (IEP) • Based on an educational assessment • Physician advocacy may be necessary

  22. Educational Supports • Re-authorization of the IDEA (1997) • Entitlement: DX 21 yrs • Special education techniques & staff • Related services (PT, OT, ST, RN) • Assistive technology • Extended year services • Non-educational services • Transitional services

  23. Components of an IEP • Current level of functioning and DX • Goals and objectives for school year • Related services needed to goals • special education • therapy (PT, OT, ST) and nursing • assistive technology devices • Frequency, duration and provider of related services

  24. Components of an IEP • Placement (LRE philosophy) • Supports needed for LRE placement • Transitional services - if > 14 years old • Extra curricular activities • Respite (“non-education funds”) • Extended year services • Recreation • Monitoring of progress • Tools • Frequency • Signatures

  25. Physician’s Role in the IEP • Authorize for svc via medical categories: • Other Health Impaired (ADHD, CHI, SZ) • Orthopedically Handicapped • Vision and/or Hearing Impaired • MR diagnoses (Down, FXS, William's) • Advocate for psychometric testing • Evaluate for co-existing health concerns…..authorize medical Rx • Coordination of services • Communication and educ (med<-- >EIP) • Advocate for related svc & assist technol

  26. Medically-based Therapy • health care service requiring physician Rx • requires insurance/HMO pre-authorization • addresses periodic life issues • new equipment (braces, crutches, W/C) • post surgical • transition to oral feeding Educational-based Therapy • provided at no cost (gov subsidized) • usually consultative • addresses devel and educ milestones • driven by the IFSP services at home • driven by the IEP services at school

  27. Assistive Technology • Purpose:to prevent (or decrease) deformity to increase function • Timing is critical and depends on DD • Low tech vs. high tech devices • Positioning • Mobility • ADL (activities of daily living) • Communication • Educational • Recreational • Service animals

  28. Assistive TechnologyClearing Houses • Abledata • RESNA • Alliance for Tech Access • TRACE

  29. Computer Technology • Apple: 1-800-600-7808 • IBM: CAT (Center for Adapted Tech) Easter Seals in Colorado Phone: 1-303-233-1666 Fax: 1-303-233-1028 • RJ Cooper Software 24843 Del Prado Dana Point CA 92629

  30. Service Dog Information • Houston: (281) 497-2505 • Austin: (512)891-9090 • Website: www.THSD.com

  31. Transition School Work Home Community Pediatric Adult Care Centered Care

  32. School Work Background: PACER Center • ADA (1990) • Rehab Act (1992):“supportive employment” • IDEA (1990 and reauthorized in 1997) Individualized Transition Plan (ITP) • supplements or replaces the IEP at age 16 • student becomes a member of the team • identify vocational goals • addresses training (OJT and volunteer) • community agencies and services • rehab counselor is important team member • evaluation of progress

  33. Home Community Training (informal &/or formal ILS classes) • early responsibility for self-care, hygiene • behavior, social skills, and leisure activities • homemaking (cooking, cleaning, laundry) • financial and budgeting • public transportation or adaptive vehicles • interview, hire, supervise & fire attendants Settings: LRE • institutional • group homes • apartments • own home with/without spouse

  34. Transition in Health Care Preparation • Encourage responsibility for own care • Should be planned, not crisis initiated • Identification of new adult provider(s) • Transition interview • Self-directed portable records • Teaching physical exam Process • Evaluate readiness* • Record sharing and open communication • Overlap in care • Then let go………. but do not abandon

  35. Transition in Health Care Barriers • lack of readiness (teen, parent, doctors) • strong emotional attachments • reluctant adult care providers • few multidisciplinary options • lack of funding

  36. Guardianship: The Alternative to Transition • Formal determination is now required at 18 years of age • Often triggered by surgery or a hospitalization • Requires legal action, not by default • petition must be filed • court hearing • Costs between $500 - $2000

  37. Guardianship • Is different from conservatorship of the estate • Responsible for all decisions except: • psychosurgery • electric shock therapy • sterilization • experimental treatments • If teen is borderline alternatives • Kinship is not the conclusive factor in determining the guardian

  38. OVERVIEW • Medical Home for CWD • Working with the educational system • IFSP and early intervention programs • IEP and the education system • ITP and transition to adulthood • Accessing community resources • parent educ, advocacy, support • community agencies • respite and recreation • financial • Educating the PCP

  39. Community Supports • In the family’s eyes, these are often more critical than medical services when caring for CWD • Lack of physician knowledge and expertise often the source of parental discontent • Surveys reveal physician-parent mismatch

  40. Levels of Support • Natural • family • neighbors • friends • Informal • clinic and IEP contacts • parent support groups • community agencies • Literature & Internet • Formal Entitlements • education (IEP and schools) • Medicaid, SSI

  41. Formal Informal Natural

  42. Informal Supports • Parent Literature and Web sites • Parent Support Organizations • Peer Support Organizations • Community Agencies • Child Care • Respite and Respite Care Waivers • Recreation • Organized Sports

  43. Parent Literature • Exceptional Parent Magazine • Monthly publication (articles, advertisments) • Special inserts (spasticity, mitochondrial DO) • Family Library • Annual Resource Guide • Web site • Search and Respond • Brookes Publishing • Woodbine House • Medic Publishing • AACPDM List

  44. CWD Web Sites for Families • Ctr of Children with CI & D • Exceptional Parent Magazine • Family Voices • MUMS (parent support) • Natl Ctr for Youth with Disabilities • National Parent Network on Disabilities • NICHCY • Our Kids

  45. OVERVIEW • Medical Home for CWD • Working with the educational system • IFSP and early intervention programs • IEP and the education system • ITP and transition to adulthood • Accessing community resources • parent educ, advocacy, support • community agencies • respite and recreation • financial • Educating the PCP

  46. CWD Web Sites for Families • Ctr of Children with CI & D • Exceptional Parent Magazine • Family Voices • MUMS (parent support) • Natl Ctr for Youth with Disabilities • National Parent Network on Disabilities • NICHCY • Our Kids

  47. Parent Support Groups • Disability-Specific Agencies • National: literature, research, referral directories, conferences • Local: parent-to-parent support, meetings, literature • Parent Training and Information Ctr • Disability rights • Advocacy training • Family Voices - political advocacy • SNAP (Special Needs Adocacy for Parents) • Internet Disability Chat Rooms

  48. Peer-Support Groups • Friends Health Connection • Winners on Wheels • NICHCY • Disability-Specific Chat Rooms • Sib-Shops (206-368-4911)

  49. Informal Supports • Parent Literature • Parent Support Organizations • Peer Support Organizations • Community Agencies • Child Care • Respite and Respite Care Waivers • Recreation • Organized Sports

More Related